Jacobson BC et al. American Society for Gastrointestinal Endoscopy (2005) ASGE guideline: the role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas. Gastrointest Endosc 61: 363–370

Based on expert opinion and analysis of existing data, the American Society for Gastrointestinal Endoscopy has published guidelines on the use of endoscopic ultrasonography (EUS) and ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) in the diagnosis and treatment of pancreatic cystic lesions and fluid collections. Cystic pancreatic lesions encompass a number of benign and malignant masses. Pancreatic fluid collections (PFCs) develop secondary to pancreatitis and pancreatic trauma and typically resolve without intervention.

The guidelines state that although EUS is not a reliable basis for treatment decision making, it can help to differentiate between types of pancreatic cystic lesions and to guide fine-needle aspiration of lesions. Levels of enzymes and tumor markers in pancreatic cysts are not specific enough to identify malignancy or to distinguish a particular type of lesion; however, cytologic analysis of cyst fluid can aid diagnosis of pseudocysts, malignancy, and mucinous or serous cystadenomas. ERCP can also reveal signs characteristic of malignancy.

Although endoscopy is not used to treat neoplastic cystic lesions, the guidelines advocate endoscopic drainage as an alternative to surgical or percutaneous drainage of inflammatory PFCs. EUS or ERCP evaluation is suggested before drainage.

Further prospective controlled trials are warranted to clarify the exact role of EUS and ERCP in the diagnosis and management of pancreatic cystic lesions and PFCs. In the meantime, however, the new guidelines recommend that, with appropriate antibiotic prophylaxis, these techniques have utility in this setting.